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TABLE OF CONTENTS
Page
Preface
3
Abbreviations
4
(1)
Recommendations on Prescription Practices / Procedures
Medication Administration Record (MAR)
Standard Intravenous (IV) Fluid and Drug Additives Administration Form
Standard Insulin Administration MAR Form
Legibility
Start Date
Drug Name
Dosage
Routes of Administration
Times of Administration
Valid Period
Signature
Transcription of Drug Order
Alterations & Cancellation of a Prescription
Electronic Prescribing (Medication Order Entry -- MOE)
Verbal Orders
Patient’s Own Medications
Drug Samples
Clinical Trial Medications
Record of All Medications
Chinese Medicines (CM)
Nurse-initiated Medications
Discharge Medications
(2)
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5
5
5
5
5
6
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6
6
7
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7
7
7
8
8
8
8
8
Recommendations on Pharmacy Drug Supply System
Pharmacy Drug Supply System
Individual Patient Dispensing
Preparation of Drugs
Accuracy in Dispensing
Labelling of Dispensed Medications
Re-packaging of Medications from the Manufacturers’ Original Containers
Drug Replenishment
Ward Stock Supplies
Emergency Drug Supplies Outside Pharmacy Service Hours
Supply of Antidotes and Detoxifying Agents in HA Hospitals
Supply of Medications for Patients during Inter-hospital Transfer
1
9
9
9
9
9
9
9
9
10
10
10
(3)
Recommendations on the Delivery / Storage of Drugs
Delivery of Drugs
Storage of Drugs
Storage of Dangerous Goods (DG)
Storage of Medical Gas Cylinders/Containers
(4)
Recommendations on Drug Administration Procedures in the Wards
Level of Nursing Personnel Involved in Drug Administration
Order and Receipt of Drug Supplies from the Pharmacy
The Principle of Three Checks and Five Rights
Administration of Intravenous (IV) Medications
Record of Administration
Recording and Reporting
Self-medication Programme
The Supply of Ward Stocks
Pooling and Relabelling of Drugs
Dispensing Outside Pharmacy Service Hours
Borrowing of Drugs
Method of Drug Return / Disposal
(5)
12
12
12
13
14
14
14
14
14
15
15
15
Recommendations on Handling Requirements for Specific Drugs
Dangerous Drugs
Cytotoxic Drugs
Hazardous Chemicals
High Risk Drugs
Medications Used in Resuscitation
(6)
11
11
11
11
16
16
16
16
16
Quality Assurance Programmes
Medication Incident Reporting Programme
Adverse Drug Reactions Reporting Programme
Quality Complaints on Pharmaceutical Items
Drug Recall
17
17
17
17
APPENDIX
Appendix 1
Lists of HA-wide Approved / Standard Abbreviations
in Prescribing
2
18
PREFACE
The full “Report on Drug Administration Procedures and Practices in Public Hospitals,
2005 edition” was prepared by the Working Group which comprises doctors, pharmacists
and nurses from the institutions under the HA. The Working Group was appointed to
review the existing drug administration systems in public hospitals and a set of
Recommended Practices was then drawn up for the improvement of the overall standard
and quality of service.
The Pocket Version is an abridged version of the fourth Chapter on Recommended
Practices of the full Report. Its purpose is to provide an easy-to-use, concise, portable
version that can be utilized for quick reference by the front-line staff. It is not intended to
replace the complete information found in the full Report.
Appendix material such as the list of HA-wide Approved / Standard Abbreviations in
prescribing is also available for reference. Prescribers should either prescribe in full text or
adhere to these lists of Abbreviations.
3
Abbreviations
The abbreviations used in this book are listed in the table below for your easy reference.
ADR
Adverse Drug Reactions
HCE
Hospital Chief Executive
A&E
Accident and Emergency
ICP
Intra-cranial Pressure
AIRS
Advanced Incidents Reporting
System
IT
Information Technology
CARS
Computerized Automatic Refill
System
IV
Intravenous
CCE
Cluster Chief Executive
KCl
Potassium Chloride
CDDH
Corporate Drug Dispensing
History
LKSSC
Li Ka Shing Specialist Clinic
CE
Chief Executive
MAR
Medication Administration
Record
CIVAS
Centralized Intravenous
Admixture Service
MI
Medication Incident
CM
Chinese Medicine
MIRP
Medication Incident Reporting
Programme
CMS
Clinical Management System
MOE
Medication Order Entry
COS
Chief of Service
MOEMET
Medication Order Entry Major
Enhancement Task
CPO
Chief Pharmacist’s Office
NCR
No Carbon Required Multi-part
Carbonless Paper
CSC
Clinical Service Coordinator
PMH
Princess Margaret Hospital
CVP
Central Venous Pressure
PMS
Pharmacy Management System
D
Director
PMS-OP
Pharmacy Management System –
Out-patient
DM
Department Manager
PYNEH
Pamela Youde Nethersole Eastern
Hospital
DTC
Drug and Therapeutics
Committee
QMH
Queen Mary Hospital
DURC
Drug Utilization Review
Committee
SOPD
Specialist Out-patient
Department
EDS
Express Dispensing System
TKOH
Tseung Kwan O
GM(N)
General Manager (Nursing)
TMH
Tuen Mun Hospital
GOPD
General Out-patient Department
TPN
Total Parenteral Nutrition
HA
Hospital Authority
YOOPD
Yan Oi Out-patient Department
HAHO
Hospital Authority Head Office
4
RECOMMENDED PRACTICES AND REQUIREMENTS
1
RECOMMENDATIONS ON PRESCRIPTION PRACTICES / PROCEDURES
Medication Administration Record (MAR)
1.1
MAR should be the ONLY official document for the entire in-patient drug
administration process i.e. on which doctors prescribe, for which the pharmacy staff
dispense drugs, and according to which the nurses administer drugs.
1.2
Personal details, diagnosis of the patient and drug allergy are regarded as essential
information to be provided in the MAR. Patients without drug allergy must be
recorded as “NIL” or “No Known Drug Allergy (NKDA)”. Prior to the prescribing
of medications, drug allergy records of the patients must be re-checked by the
doctors.
Standard Intravenous (IV) Fluid and Drug Additives Administration Form
1.3
The drug order and administration of intravenous infusion and drug additives are
to be recorded in the “IV Fluid and Drug Additives Administration Form”.
1.4
Doctors should review the intravenous drug orders on a daily basis.
Standard Insulin Administration MAR Form
1.5
The order and administration of insulin are to be recorded in the “Insulin
Administration / Blood Glucose Monitoring Form” and “Intravenous Insulin
Administration Form (DKI or IV insulin pump)” recommended to the hospitals’
DTCs.
Legibility
1.6
Doctors should prescribe in a clear and legible manner.
1.7
Doctors are required to write FIRMLY on the MAR with indelible ink.
Start Date
1.8
This date on which a drug treatment is to commence should be recorded.
Drug Name
1.9
All drugs should be prescribed by their approved name and should preferably be
printed in full in BLOCK LETTERS.
5
1.10
Doctors should either prescribe in full text or adhere to the list of standard
abbreviations (refer to Appendix 1 of the Pocket Version).
Dosage
1.11
The dose of medications should be prescribed using the METRIC system. Dosage
should be expressed in terms of the active ingredients except in the case of
compound preparations.
1.12
Dosage abbreviations and decimal points should be avoided. Microgram should be
written in full instead of mcg or μg. Units should be written in full instead of i.u.
Routes of Administration
1.13
Doctors should either prescribe in full text or adhere to the list of standard
abbreviation (refer to Appendix 1 of the Pocket Version).
Times of Administration
1.14
Times of administration schedule should be clearly given. If abbreviations are to be
used, doctors should adhere to the list of standard abbreviations (refer to Appendix
1 of the Pocket Version).
1.15
For “ONCE ONLY” medications, the date and time of administration should be
specified.
1.16
For “AS REQUIRED” medications, the reasons for treatment, the maximum
frequency of administration and/or the times of administration should be stated.
1.17
For “ONCE DAILY" medications, the full text ‘daily’ should be used and the time of
administration should be specified.
Valid Period
1.18
When a certain medication is to be given for a defined period, this should be clearly
stated e.g. antibiotics.
Signature
1.19
Doctor must put their identification code or full name in block letters together with
their authorised signature on all the prescriptions.
Transcription of Drug Order
1.20
A copy of the MAR in the doctor’s original handwriting should be sent to the
pharmacy by using the NCR paper or by fax.
6
Alterations & Cancellation of a Prescription
1.21
No prescription item should be altered in part. Any changes in a prescription order
should involve the complete cancellation of the existing prescription item and the
writing of a new one.
1.22
Medications should be cancelled by drawing a diagonal line through the drug name
and/or a slanted double-line across the administration section and must be signed
and dated.
Electronic Prescribing (Medication Order Entry -- MOE)
1.23
Discharge and home leave prescriptions can be prescribed through the Medication
Order Entry (MOE) system.
Verbal Orders
1.24
Only in emergency and approved circumstances may a verbal order be given. The
instruction must be recorded immediately in the patient’s MAR and annotated it a
‘verbal order’.
1.25
After the instruction has been written, it must be READ BACK to the doctor.
1.26
The nurse receiving the message must administer the drug and personally give
both verbal and written instructions to the nurses taking over from him/her.
1.27
A verbal order must be confirmed in writing by the doctor concerned within 24
hours at the latest.
1.28
Dangerous Drugs should not be ordered through verbal orders.
Patient’s Own Medications
1.29
The patient’s own medications should not normally be administered in hospital
unless they have been positively identified, specifically prescribed by the doctor
and when supplies are not immediately available from hospital sources.
1.30
If the patient’s own medications are to be administered in hospital, identification,
prescribing and administration of the patient’s own medications should follow the
protocol / logistics endorsed by the hospitals’ DTC.
Drug Samples
1.31
The hospital DTC or an equivalent committee should establish policies and
procedures to approve, control and monitor the use of drug samples in the
hospitals and their affiliated clinics.
7
1.32
Drug samples approved for use must be dispensed by the pharmacy.
Clinical Trial Medications
1.33
Individual hospitals should draw up their own protocols regarding the supply,
storage, preparation and distribution of clinical trial medications.
1.34
Appropriate details regarding such clinical trial medications should be supplied to
the pharmacy before the commencement of the clinical trial.
Record of All Medications
1.35
All medications including routine drugs, clinical trial medications, brought-in
drugs, drug sample, intravenous fluid, insulin and TPN should be prescribed
properly and their administration recorded accordingly.
Chinese Medicines (CM)
1.36
The use of CM in the HA hospitals should follow the guiding principles of the
“Hospital Authority Guidelines on Interface Issues between Chinese Medicine and
Conventional Western Medicine”.
1.37
The use of CM should be indicated by the doctors on the MARs as “Chinese
Medicines”. The MARs should be sent / faxed to the Pharmacy for computer entry
and the administration of CM should be properly recorded.
Nurse-initiated Medications
1.38
The protocols approved by the hospital DTC should specify the rank of nurses
allowed to initiate medications on the approved list.
1.39
Medications initiated by nurses should be checked and countersigned by a doctor
within 48 hours for non-poisons and 24 hours for poisons.
Discharge Medications
1.40
Doctors should prescribe all the medications that the patients are currently taking
and not just those required for discharge.
1.41
When the supplies of certain medications are not required, they should be clearly
indicated on the prescription or in the MOE.
8
2
RECOMMENDATIONS ON PHARMACY DRUG SUPPLY SYSTEM
Pharmacy Drug Supply System
2.1
The Pharmacy drug supply system comprises individual patient dispensing and
ward stock supply.
Individual Patient Dispensing
2.2
The majority of inpatient medications should be supplied on an individual patient
basis by the pharmacy. It enables the pharmacist to verify the safety and
appropriateness of each prescription order.
Preparation of Drugs
2.3
Pharmacists should supply drugs in the most appropriate form or the most readyto-administer form.
Accuracy in Dispensing
2.4
Proper in-house checking procedures should be built into the pharmacy dispensing
system. Every prescription order and all dispensed medications should preferably
be checked by a pharmacist.
2.5
Mere checking of the label against the content is not sufficient. Reference should
always be made to the ORIGINAL prescription for the correctness of the drugs and
possible undesirable drug interactions. The double check system should be
practised whenever possible.
Labelling of Dispensed Medications
2.6
Proper labelling should be provided on all dispensed medications in compliance
with the requirements for mandatory labelling of medications.
Re-packaging of Medications from the Manufacturers’ Original Containers
2.7
The re-packed drugs should be properly labelled with a retraceable batch reference
and proper records should be kept.
Drug Replenishment
2.8
Proper recording and checking mechanisms should be in place to facilitate the
replenishment and recall of drugs.
Ward Stock Supplies
2.9
To maintain the continuity of drug supplies outside pharmacy service hours, ward
stocks will still be required.
The following points are to be considered for
maintaining a proper ward stock system :9
(a) The reasons for keeping ward stocks must be well established.
(b) Those items that have commonly been involved in potential or serious
medication errors should not be kept as ward stock in general care areas e.g.
concentrated KCl injection.
(c) All ward stock items must be supplied in appropriate labelled containers.
(d) The range of ward stocks and the quantity kept for each item should be
minimised.
(e) A list of ward stock items should be maintained and periodically reviewed.
(f) Pharmacy staff should be actively involved and responsible for the whole
process of ward stock management e.g. by using a bar-code topping up system.
(g) In the absence of barcode topping up system, the “two bottle system” should be
employed.
Emergency Drug Supplies Outside Pharmacy Service Hours
2.10
Access to a limited supply of medications from the Night Cabinet outside
Pharmacy service hours should be made available to medical or nursing staff.
2.11
The drug items should be kept in the Night Cabinet which is kept locked when not
in use.
2.12
The container for each item should be properly labelled.
2.13
When a medication order must be made at the time of emergency drug supply,
such medication order should be verified by the pharmacy staff and the drug item
replenished within 24 hours.
Supply of Antidotes and Detoxifying Agents in HA Hospitals
2.14
Certain antidotes and detoxifying agents are stocked in some HA hospitals (refer to
Appendix 7 of the full Report).
2.15
Arrangement should be made through the hospital pharmacy if any of these agents
are required.
Supply of Medications for Patients during Inter-hospital Transfer
2.16
The medications supplied should be properly labelled. The detailed HAHO
guidelines are shown in Appendix 8 of the full Report.
10
3
RECOMMENDATIONS ON THE DELIVERY / STORAGE OF DRUGS
Delivery of Drugs
3.1
Drugs should be delivered in locked receptacles.
3.2
Separate receptacles should be used for refrigerated items and cytotoxic drugs.
Storage of Drugs
3.3
Drug trolleys with separate receptacles for keeping the individual patients’
medications should be used on the wards.
3.4
Ward drug cupboards and drug trolleys have to be kept locked when not in use
and to be kept out of reach of patients.
3.5
DD should be kept under lock and key in a designated drug cabinet at all times.
3.6
Pharmaceutical refrigerators which are used for the proper storage of drugs in
wards and in pharmacy should be used solely for this purpose.
3.7
Medicinal products for external use should be stored in a SAFE place and should be
kept separately from the drug items that are for internal use.
Storage of Dangerous Goods (DG)
3.8
Dangerous Goods (DG) should be stored at designated places in the clearly labelled
chemical storage cabinets. For details, end-users should refer to (1) Factories and
Industrial Undertakings (fire precautions in notifiable workplaces) Regulation, Cap.
59V, Section 9 for storage of inflammable substances and (2) Dangerous Goods
General from the Fire Services Department.
Storage of Medical Gas Cylinders/Containers
3.9
The storage of medical gas cylinders must comply with the provisions of the
Dangerous Goods (General) Regulations. For details, end-users should refer to the
Medical Gas System Operation Manual on cpo.home of HA intranet.
11
4
RECOMMENDATIONS ON DRUG ADMINISTRATION PROCEDURES IN
THE WARDS
No medications should be administered to a patient if a drug order is unclear or when
there is doubt in the appropriateness and safety of the patients.
Level of Nursing Personnel Involved in Drug Administration
4.1
A Registered Nurse is competent to administer medications on his/her own.
4.2
It is advisable to have a second person counter check the drug administration
process especially in situations where skill, experience and familiarity with the
clinical conditions are required to ensure safe practice.
4.3
Enrolled Nurses can administer medications, when delegated this duty by
Registered Nurses.
4.4
Nurse learners who have undergone training in medication administration and are
deemed to be competent, may administer medications under the supervision of
qualified nurses.
Order and Receipt of Drug Supplies from the Pharmacy
4.5
All drugs orders should be sent to the pharmacies for vetting irrespective of
whether the supplies of drugs are required.
4.6
All “discontinued” medications on the MAR should be faxed to the pharmacy as
soon as possible.
4.7
All drugs delivered to wards must by checked by the authorized nursing staff as
soon as they are received.
The Principle of Three Checks and Five Rights
Check patient’s identity according to the patient identification guidelines.
4.8
In drug administration, the following principle of “three checks and five rights”
should always be observed. These include :THREE CHECKS
(i) First check: Careful checking BEFORE taking the medication out from the
container.
(ii) Second check: Careful checking AFTER removing the medication from the
container.
12
(iii) Third check: Final checking of the medication against the container before
disposal/putting it away.
FIVE RIGHTS
(i) Right patient: Check the identity of the patient. Check the patient’s name and
that the name of the drug corresponds with the prescription. Check the patient’s
drug allergy.
(ii) Right drug: Nurses should refer to the MAR for the administration of drugs.
Read the prescription. Ascertain which drug is due to be given.
(iii) Right dose: Caution should be exercised in the calculation of dose especially
the high risk drug items.
(iv) Right route: Check the route of administration & ensure the right mode of
administration on the prescription.
(v) Right time: Check the time of administration against the doctor’s prescribed
directions on the MAR.
4.9
Should nurses have any doubt during the course of the procedure, they should
withhold drug administration until verification by the doctor or another Registered
Nurse.
Administration of Intravenous (IV) Medications
4.10
Nurses should always refer to the product inserts or contact the pharmacy
department of their hospitals for guidelines on parenteral drugs administration in
the case of any uncertainty.
4.11
The drug order of a high risk intravenous medication should be independently
checked by 2 nurses to ensure that the order has been correctly interpreted and that
the drug, dose calculations, preparations, route & mode of administration are
accurate.
4.12
Extreme care should be exercised with those intravenous drugs which can never be
given by bolus but only by infusion. The dose calculation should preferably be done
by a pharmacist.
4.13
The bolus of IV dangerous drugs should preferably be administered by a doctor.
4.14
Syringes containing drugs should be properly identified in order to prevent any
mix-up of medications. In no circumstances should any unidentified drugs be
given to patients and they MUST BE discarded immediately when found.
13
4.15
The IV line and non-IV tubing should be traced back carefully to the site of
insertion before drugs or feeds are administered.
4.16
Double checking should be practised when setting up infusion pumps for infusing
high risk drugs.
4.17
A uniform colour-code for stopcocks has been adopted to facilitate venous / arterial
line identification. The guidelines on the use of three-way and four-way stopcock
are depicted in Appendix 10 of the full Report.
Record of Administration
4.18
The date, time of administration and signature should be entered immediately after
the drug has been given and consumed by the patient.
4.19
The date, time of administration and the amount of IV fluid and drug additives to
be given and signature should be entered in the IV Fluid and Drug Additives
Administration Form.
Recording and Reporting
4.20
Any reasons leading to an omission in drug administration should be recorded on
the patient’s MAR. The doctors concerned should always be informed.
4.21
Nurses should record and report the effects and side-effects of the treatment
experienced by the patient.
Self-medication Programme
4.22
Individual hospitals should establish protocols for carrying out this programme.
Pharmacist should provide patient education and counselling on the use of drugs.
Nursing staff should provide appropriate supervision and the assessment of the
patient is to be documented.
The Supply of Ward Stocks
4.23
Ward stocks should be stored in an orderly manner. The practice of the rotation of
stock should be observed.
Pooling and Relabelling of Drugs
4.24
Pooling, transferring, repackaging and relabelling of ward stocks should be
avoided.
4.25
Labels originally provided by the pharmacy should NOT be altered or amended.
14
Dispensing Outside Pharmacy Service Hours
4.26
For the dispensing of A&E and other prescriptions outside pharmacy service hours,
the local policy of individual hospital should be followed.
4.27
Dispensing of ward stock medications by doctors or nurses for home leave and on
discharge is not recommended. When this is unavoidable, the medication
dispensed should be clearly labelled.
Borrowing of Drugs
4.28
Borrowing drugs from another patient’s supply or from other wards should be
restricted to exceptional circumstances.
Method of Drug Return / Disposal
4.29
Local policies regarding ward drug returns and disposal should be followed and
any other required documentation completed.
4.30
Antibiotics, dangerous drugs, poisons, other pharmaceutical products and cytotoxic
drugs in bulk or significant residue volume in container (e.g. unused or partially
used drugs in ampoules or syringes) should be disposed according to the
guidelines set up by Environmental Protection Department for disposal as
stipulated in Appendix 13 of the full Report.
15
5
RECOMMENDATIONS ON HANDLING REQUIREMENTS FOR SPECIFIC
DRUGS
Dangerous Drugs
5.1
Refer to Appendix 14 of the full Report for the guidelines on the handling of DD in
HA hospitals.
Cytotoxic Drugs
5.2
Individual hospital should draw up local policies with regard to the handling and
disposal of cytotoxic drugs.
Hazardous Chemicals
5.3
Each hospital should establish a Comprehensive Chemical Safety Programme in
compliance with the Occupational Safety and Health Ordinance (OSHO) and
Subsidiary Regulations.
High Risk Drugs
5.4
Particular caution should be exercised regarding the high risk drugs that have been
involved in potential or serious medication errors, e.g. digoxin, concentrated KCl
injection.
Medications Used in Resuscitation
5.5
The medications used in resuscitation are stocked in the emergency trolley and
emergency-kit (E-kit).
5.6
The medications used must be specific and consistent within the same specialty of
the cluster / hospital. The conditions and expiry dates of the medications should
be checked periodically and records kept of such check.
5.7
A mechanism should be established for expiry dates monitoring, medication
replenishment and replacement/exchange of medications used in resuscitation.
5.8
All medications ordered and administered should be documented in the MAR /
resuscitation forms as soon as possible or within 24 hours of the CPR process
whichever is the earlier.
16
6
QUALITY ASSURANCE PROGRAMMES
Medication Incident Reporting Programme
6.1
Medication incidents including “near-miss” cases in HA hospitals should be
reported locally in each hospital using standardised forms (refer to Appendix 15 of
the full Report).
6.2
Completed reports are directed to the hospital DTC or its equivalent. The
Committee should also report quarterly statistical data as well as the details of cases
of severity index 1-6 to the HAHO using the standardised return forms.
6.3
The HAHO will monitor the overall trend of medication incidents and consider
appropriate corporate-wide measures.
6.4
Each hospital unit should also establish a quality assurance/risk management
mechanism.
Adverse Drug Reactions Reporting Programme
6.5
Doctors, nurses and pharmacists should be alert to the potential for or presence of
ADR. A standard procedure to record and report clinically significant ADRs has
been established in the HA (refer to Appendix 16 of the full Report).
Quality Complaints on Pharmaceutical Items
6.6
All cases of quality complaints must be reported by using the standard report form.
(refer to Appendix 17 of the full Report).
Drug Recall
6.7
Pharmacists must comply immediately with any warning or recall about defective
medicines.
6.8
All drugs should preferably be kept in their original containers with their unique
lot/batch number.
6.9
When a drug recall is activated, pharmacy must notify all parties concerned
immediately.
6.10
All affected stock must be quarantined pending further instructions.
17
Appendix 1
Lists of HA-wide Approved / Standard Abbreviations in Prescribing
Prescribers should either prescribe in full text or adhere to the following lists of
approved Abbreviations:
1)
Standard Drug Name Abbreviations
DRUG
Acetomenaphthone
Adenosine Triphosphate
Adrenocorticotrophic Hormone
Adsorbed Diphtheria & Tetanus Vaccine
Adsorbed Diphtheria, Tetanus & Pertussis Vaccine
Alpha Tocopheryl Acetate
Alpha Tocopheryl Nicotinate
Ascorbic Acid
Bacillus Calmette Guerin Vaccine
Calcium Carbonate
Calcium Chloride
Carmustine
Cisplatin
Cyanocobalamin
Cytarabine
Desmopressin
Ergocalciferol, Calciferol
Erythropoietin
Etoposide
Ferrous Sulphate
Filgrastim
Fluorouracil
Glyceryl Trinitrate
Hepatitis B Immune Globulin
Isoniazid
Lomustine
Magnesium Chloride
Magnesium Sulphate
Measles/Mumps/Rubella Vaccine
Mercaptopurine
Methotrexate
Molgramostim
Phenoxymethylpencillin
Phytomenadione
Potassium Chloride
Potassium Iodide
Potassium Permanganate
Propylthiouracil
Prostaglandin E2
Pyridoxine Hydrochloride
Riboflavine
Sodium Bicarbonate
18
ABBREVIATION
Vit. K
ATP
ACTH
DT
DTP
Vit. E
Vit. E
Vit. C
BCG Vaccine
CaCO3
CaCl2
BCNU
CDDP
Vit. B12
Ara-C
DDAVP
Vit. D2
EPO
VP-16
FeSO4
G-CSF
5-FU
GTN, TNG
HBIG
INAH
CCNU
MgCl2
MgSO4
MMR Vaccine
6-MP
MTX
GM-CSF
Pencillin V
Vit. Kl
KCl
KI
KMnO4
PTU
PGE2
Vit. B6
Vit. B2
NaHCO3
DRUG
Sodium Chloride
Teniposide
Thiamine
Thyrotrophin-releasing hormone
Thyroxine
Liothyronine Sodium
Zinc Oxide
ABBREVIATION
NaCl
VM-26
Vit. B1
TRH
T4
T3
ZnO
Reference :
1. Martinadale, The Extra Pharmacopoeia, 34th edition, The Royal Pharmaceutical
Society of Great Britain.
2. American Hospital Formulary Service (AHFS) Drug Information 2002, Authority of
the Board of Directors of the American Society of Health-System Pharmacists
3. Medline Plus® (Medical Dictionary – The US National Library of Medicine and the
National Institutes of Health)
HA-wide Approved Local Drug Name Abbreviations
DRUG
Balance Salt Solution
Dihydrocodeine Tartrate
Expectorant Stimulant
Hydrocortisone 1% & Clioquinol 3%
Multivitamin
Vitamin B Complex
ABBREVIATION
BSS
DF118
MES
H1V3
MV
Vit.B Co
2) Standard Abbreviations for the Route of Administration
ABBREVIATION
EXPLANATION
I.D.
Intradermal
I.M.
Intramuscular
I.V.
Intravenous
For intravenous injection, whether it is bolus, slow IV
or infusion should be specified.
I.P.
Intraperitoneal
N.G.
Nasogastric
P.O.
Per oral
P.R.
Per rectum
P.V.
Per vagina
S.C.
Subcutaneous
S.L.
Sublingual
19
3) Standard Abbreviation for Drug Administration Frequency
INSTRUCTION
LATIN
ABBREVIATION
once daily
once daily
twice a day
bis die
b.d.
twice a day
bis in die
b.i.d.
three times daily
ter die sumendus
t.d.s.
three times daily
ter in die
t.i.d.1
four times daily
quater in die
q.i.d.2
four times daily
quater die sumendus
q.d.s.
at bedtime
hora somni
h.s.
at night
nocte
noct.
every night
omni nocte
o.n.
every morning
omni mane
o.m.
before noon
ante meridiem
a.m.
afternoon
post meridiem
p.m.
when required
pro re nata
p.r.n.
used as directed
more dicto utendus
m.d.u.
immediately
statim
stat.
alternate
alternus
alt.
before food
ante cibum
a.c.
after food
post cibum
p.c.
_______________________
1 t.i.d. is preferable to be used in prescription
2 q.i.d. is preferable to be used in prescription because q.d.s. is easily mistaken with q.d.
4) Standard Abbreviations for Dosage Forms
DOSAGE FORM
LATIN
ABBREVIATIONS
capsule
capsula
cap.
drops
guttae
gtt.
for the eye
oculo
ocul.
irrigation
irrigatio
irrig.
mixture
mistura
mist.
ointment
unguentum
ung.
pessary
pessus
pess..
powder
pulvis
pulv.
suppository
suppositorium
supp.
syrup
syrupus
syr.
tablet
tabletta
tab.
tincture
tinctura
tinct.
Reference : Pharmaceutical Handbook, The Pharmaceutical Press
Pharmaceutical Practice, D.M. Collect, M.E. Aulton
The Chief Pharmacist’s Office is responsible for coordinating the procedures involved in the addition of drug
abbreviation. Any request for addition of drug abbreviation should be made through the hospital pharmacy.
HAHO 2000 (revised in Jan 05)
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